Patients have reported to have metal allergies in the form of gingivitis, burning sensation, gingival hyperplasia, numbness on sides of tongue especially to nickel present in space maintainers and stainless steel crowns. īishara SE et al., and Agaoglu G et al., reported that orthodontic appliances, used in oral cavity corrode in the oral environment releasing both nickel and chromium. The comparison between the aesthetic space maintainers is depicted in. Certain disadvantages as corrosion and appliance fracture, have led to the development of more aesthetic and metal-free space maintainers which include Fibre Reinforced Composite Resin (FRCR) space maintainer and CAD-CAM aided ceramic band and loop space maintainer. Various space maintainers as band and loop, crown and loop and lingual arch space maintainers are routinely used in dentistry. Hence, the space maintainer was recommended immediately after extraction of the tooth. In a study by Richardson, he stated that maximum amount of space loss occurs in the first six months post extraction. According to Northway WM, when the maxillary primary first molar is lost prematurely, the first premolar erupts in a more mesial direction than normal, due to the mesial incline of the primary second molar, and consumes the space of the permanent canine, which becomes blocked out, exhibiting a more deleterious effect. Premature loss of primary molars also cause a reduction in arch length.
Also, the eruption of the first permanent molar was not to its full occlusal level and it might cause forces on the primary second molar causing the tooth to drift in the space of the first primary molar which was extracted, leading to blockage of the first permanent premolar. Since, teeth do not erupt till two-thirds of the root is completed (Nolla’s stage 8) thereby, a space maintainer was absolutely necessary. Space maintainers are a routine appliance used in paediatric dentistry for proper maintenance of space for the succedaneous permanent tooth in case of early removal of the primary tooth.Ī space maintainer was advocated in the present case as the intraoral periapical radiograph revealed an incompletely formed first premolar where the crown of the tooth was almost completed (Nolla’s stage 5) with no sign of root formation. One of the critical function of primary teeth is maintenance of space for the successional permanent teeth. Extraction of the tooth followed by a ceramic space maintainer was decided as the treatment plan. After complete clinical and radiographic examination, a diagnosis of chronic intra-radicular abscess was made for the involved tooth. On the radiograph, only the crown of the permanent first premolar was seen to have formed with no signs of root formation. Radiographic examination revealed presence of a large radiolucency in the coronal portion of the involved tooth involving the pulp with complete resorption of mesial and distal roots. Electric Pulp Testing (EPT) results showed no response in the involved tooth as compared to the contralateral healthy tooth. Diagnostic tests revealed negative response to hot and cold tests. There was a history of intraoral swelling five days back which subsided on intake of medications. The patient had a history of severe pain on intake of hot and cold fluids 15 days back which relieved on its own without any intervention.
There was an associated sinus opening adjacent to the involved tooth about 2 cm above the free gingival margin on the buccal side. On clinical examination, there was presence of a large deep carious lesion involving the right maxillary primary first molar. At the end of six months, the patient was completely asymptomatic and there were no visible signs of gingival inflammation and tissue irritation at the site of the space maintainer.Ī six-year-old female patient reported to the Department of Pedodontics and Preventive Dentistry, Manubhai Patel Dental College, Vadodara, Gujarat with chief complaint of pain in the upper right back tooth since 15 days.
Clinical and radiographic examinations were performed at one and six months. A six-year-old female patient with chronic intra-radicular abscess in upper right first primary molar was treated with extraction followed by the placement of BruxZir zirconia space maintainer.
To prevent the space loss, space maintainers are designed and delivered at the time of extraction to allow for development of proper functional occlusion in children till the eruption of the succedaneous permanent tooth. Premature extraction might lead to loss of space for the successor tooth, drifting of teeth and loss of arch integrity leading to malocclusion in the permanent teeth. Premature extraction of deciduous teeth is a common sequeale of untreated dental caries in teeth in which the damage is far beyond repair. An ideal occlusion with proper tooth alignment and fully functional teeth is the ultimate goal of all dental treatments.